Active NPI
Stacy Lynne Pettinger, MA,CCC-SLP
- Speech-Language Pathologist
- Sycamore, IL
National Provider Identifier
1578823449
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146.006059
- Practice address
- 1715 Dekalb Ave
Suite 125
Sycamore, IL 60178-2736 - Phone
- (815) 991-5760
- NPI assigned
- May 24, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 146.006059 | IL | Primary |
Addresses
Primary practice location
1715 Dekalb Ave
Suite 125
Sycamore, IL 60178-2736
Mailing address
1825 JC Kellog St
Sycamore, IL 60178-8782
Phone (815) 895-0002
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146.006059 | IL | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| RG-Rhinelander, Inc. | Past | Accepting new patients | |
| Hillmann Pediatric Therapy | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1337817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337817600000",
"number": "1578823449",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1825 JC KELLOG ST",
"city": "SYCAMORE",
"state": "IL",
"postal_code": "601788782",
"telephone_number": "815-895-0002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1715 DEKALB AVE",
"address_2": "SUITE 125",
"city": "SYCAMORE",
"state": "IL",
"postal_code": "601782736",
"telephone_number": "815-991-5760"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTINGER",
"first_name": "STACY",
"middle_name": "LYNNE",
"name_prefix": "Mrs.",
"credential": "MA,CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-05-24",
"last_updated": "2012-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146.006059",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sycamore, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.